​Authors investigate the relationship between ISO 9001 certification, health care accreditation, and quality management in European hospitals: 73 acute care hospitals with a total of 291 services managing acute myocardial infarction, hip fracture, stroke, and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey. Four composite measures of quality and safety (specialized expertise and responsibility, evidence-based organization of pathways, patient safety strategies, and clinical review applied to four pathways.

Findings: Accreditation in isolation showed benefits in acute myocardial infarction and stroke more than in deliveries and hip fracture; the greatest significant association was with clinical review in stroke. Certification in isolation showed little benefit in acute myocardial infarction but had more positive association with the other conditions; greatest significant association was in patient safety strategies with stroke. 

The combination of accreditation and certification showed least benefit in evidence-based organization of pathways but significant benefits in specialized expertise and responsibility (acute myocardial infarction), in patient safety strategies (acute myocardial infarction, hip fracture, and stroke) and in clinical review (acute myocardial infarction and stroke). 

Accreditation and certification are positively associated with clinical leadership, systems for patient safety, and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care.